This blog documents the journey of Marla Crider, a 60 year-old travel professional from Little Rock, Arkansas, as she battles a breast cancer called invasive ductal carcinoma (stage 3). From the moment of her diagnosis, she chronicles her experience. Be forewarned this blog may provide a raw glimpse into the author’s psyche and ability to deal with a life threatening challenge. Hopefully, her honesty and humor will provide advice and help to others who find themselves in a crusade of their own.

Thursday, May 30, 2013

New Doctors - Intimidating Facility

It was the day after the official diagnosis ofinvasive
ductal carcinoma, and I was already being whisked into the chief of oncology’s
office at the University
of Arkansas for Medical
Sciences – by choice.Thanks to Don’s
medical connections, I have the privilege of consulting with some of the
country’s best medical professionals.Rest assured that I haven’t and won’t take this opportunity for granted.

At 10:30 a.m. on May 9, my life was no longer my own.I officially turned it over to a minimum of five doctors and an army of nurses at my new home away from home – UAMS. The day started in the Winthrop P. Rockefeller Cancer Institute’s
BreastCenter.The paperwork was comprehensive, as
expected.The orders say to arrive at
least 30 minutes early, and it’s always about the paperwork.

Finally, Don and I were escorted to a cubicle to await the
arrival of the oncology chief, Dr. Westbrook.His silver hair with a tinge of red dominated his jolly face.“Well, young lady, I’m here to confirm that
you have Grade 3-Stage 3 breast cancer,” he said. “You will need a mastectomy,
rather than a lumpectomy, because of the mere size of the tumor.”Ok, I thought, that’s out there pretty
quickly.I’m only one day into digesting
the confirmation that I even have breast cancer and it’s already time to cut
off the little ta-ta. Whee!My cancer-surviving friends said that things
would really start moving fast, and they weren’t kidding.

While Dr. W. was still discussing the seriousness of my
disease, a tall, female doctor with short, dark hair and a slight slump in her
shoulders came into the room with hand extended and introduced herself as Dr.
Suzanne Klimberg.Wow! It was THE
Suzanne Klimberg, elected recently as the President of the American Society of
Breast Surgeons. I have been blessed with the best.

She immediately started checking for lymph swelling in my
neck, shoulders and under my arms.She
manually felt the mass and said it was “good-sized” (hmmmm, don’t know if I would
have used the adjective “good,” but ok) one that would definitely require
surgery.But first, she said, we would
do chemotherapy to reduce the size of the mass. This process will help save
more tissue and skin for reconstructive surgery.

She momentarily excused herself and returned with a medical
book that she quickly and proudly introduced as her publication in which she
and Dr. Yuen, my yet-to-meet plastic surgeon, wrote together.She showed me numerous “before and after”
photos of previous breast reconstruction surgeries. I’m convinced.She even told me I could pick any sized ta-tas I wanted. JMore about that later.

Dr. Klimberg wanted to do a lymph node ultrasound to see
where we stood with that possible issue.I asked when I needed to return for that test.She said, “You’re here; let’s do it now.”Really?Really!So off I go to a dark
little procedure room, disrobe and plop the girls on the gurney for another
ultrasound – this time, with my right arm over my head.She talked me through what she was
seeing.And, then came the “hmmmm.”

She said she wanted to do a needle biopsy…right then and
there.My how fast things move at
UAMS.

Dr. Klimberg prepped me and personally administered the
local anesthetics. Not too bad.Once again, I heard the clicking sound
indicating when she was cutting the tissue for microscope review. When she
completed the process, she stood for more than 10 minutes holding pressure on
the wound to make sure I wouldn’t bleed.We conversed the entire time.She’s
such a soothing and knowledgeable surgeon.Love this woman!!

My mind was finally accepting the inevitable and ready to
make a plan for a cure.I’m going to be
cancer’s worst enemy! Oh, by the way, the lymph node biopsy from under the
right arm came back negative.Finally!Some good news.

Over the next 2 ½ weeks, my visits to UAMS went something
like this:

May 10 – Breast MRI – Guess
what I have invasive ductal carcinoma in the right breast and it’s large. Nice
to have an expensive confirmation. (Sorry, sometimes the sarcasm just rolls
across my tongue!)

May 17 – Dr. Issam Makhoul – Oncologist – This blessing of a doctor spent nearly three
hours with Don and me talking us through the entire process of chemo, what to
expect when, etc. One of the most important (and interesting) things Dr.
Makhoul told me was that the second day after each treatment, I would come back
to UAMS for a Neulasta injection to stimulate extra white blood cells to help
fight infections.He said that in many
cases it’s the chemo related infections that cause people to die, not the
cancer itself.None of what Dr. Makhoul
said scared me.In fact, it got me in my
fighting mode. Bring on the chemo.Let’s
get this insidious disease out of me.

May 20 – Dr. Hardee – Radiation Oncologist – When the doctor entered the room,I could have sworn he was 12 years-old. Young or not, the dude knew his stuff. He
answered every question I had with authority and knowledge and explained that I
might not have to have radiation after the chemo.Only the surgery would tell the tale along
with the lymph node harvesting. Dr. Hardee is also on the Westbrook, Klimberg,
Makhoul breast cancer team – MY team.

May 22 – Port Placement and MUGA Scan – UAMS can be a difficult campus to navigate.Patients must allow time to move around the
WPR Cancer Institute, the Outpatient Clinic, and the Nuclear Medicine
area.After a brief workout walking from
one end of WPRCancerCenter
and the place for the port placement, I was ready for a shower.After more paperwork, my name was called by Dr.
McDreamy – no, really – this young resident was scrumptious, and my inner
cougar made an unexpected appearance..I
told Don the procedure might not be so bad, after all. He just rolled his eyes. Dr. McDreamy accompanied me to the procedure
room, where a male RN that could have been a Vin Diesel double, big biceps and
all, assisted me on the gurney.Again,
the tag-team told me every move they were making. I didn’t really care; I was too busy looking
at my medical team.They hooked me up to the ultrasound to find the
correct vein under the left collarbone (the placement is almost always on the
opposite side of the cancer).Then I
hear them chattering about how they can’t see it - the vein.NOTE:If you have small, rolling veins, like me, just get ready.They pull tricks out of their scrubs to
assist in this, sometimes, impossible task of finding veins.And I did say TRICKS. Nurse
Diesel tilted the gurney, head down, to increase the blood flow to the
neck.It worked.Dr. McDreamy administered the first of the
locals.Not unbearable.He fished the line down through the
vein.Then came the port hook-up.More local anesthesia to deaden a broader
area where Dr. McDreamy and Nurse Diesel would make the incision and create a flap
to hold the port.Ummmm….this time I
took my eye off the prize (Dr. M) and the local really got my attention. Once
finished with that, he tugged and pulled skin to cover the round port, then
stitched me up internally and used glue for the exterior.I’m not going to lie. When that little ¾”
port area “woke up,” I wanted to slap one young, beautiful resident.It took about two days for the achy feeling
to subside then my inner cougar was raring to go, again.

MUGA Scan (same day as port placement) – This is
a heart scan with contrast dye to confirm the heart can withstand the burden
that can come with chemo treatment.First, I’m pleased to tell all those who have called me a heartless bee-atch
over the years, I do have a heart.I
even have a scan of it for proof.And,
it’s ticking along just fine.

May 24 – PET Scan – Since
I am an insulin dependent diabetic (thank you, Crider genes), this test is a
little different.Because the
technicians basically inject the patient with pure, radioactive sugar, I wasn’t
allowed to take my daily injection or any of the oral meds.Needless to say, I couldn’t eat or drink
anything for six hours leading to the appointment -it was scheduled at 1 p.m. - and my evening meal the night before was a
piece of fish with broccoli – yum!!When
another cutie medical professional escorted me into the steel-doored cubicle,
he immediately began looking for a vein.

To make the job easier
on the poor lab techs that cross my path these days, I automatically say:butterfly needle and vein finder.I learned quickly that lab techs hate to use
the vein finders because they think it signifies technique inefficiency. Heck,
just don’t stick me two or three times trying to find one of my little blue
veins, that’s all that matters to me.The tech was almost relieved when I suggested the vein finder.Finally, he discovered a good vein and
quickly collected a blood sample into a vial, then injected me with the
radioactive sugar.He handed me a large Styrofoam
cup with a concoction in it (uh, Styrofoam isn’t “green” is it?Shame on UAMS!).He said it was for the PET scan
contrast.It was orange flavored.Frankly, I was so hungry and thirsty, that I
could have consumed pure lemon juice and thought it was champagne! The tech
gathered all the remnants of his vein-finding debacle and hit the steel door
button on the side of the wall and said he would see me in two hours.Then, the steel door slammed shut and made
the sound like you hear on cheap, public service announcements about not drinking
and driving.

Exactly two hours
later, the tech opened the steel door and came for me and into the round tube I
went.The scan took about 30
minutes.In all honesty the hardest part
was going to be waiting for the results.You see, this is the granddaddy of all the scans.It tells where any and all cancer is located
in your body.The plan was for Dr.
Makhoul to divulge the results to me immediately before the first chemo
treatment on May 28.I’m in for a long,
long weekend. Hurry up chemo treatment.Let’s get this show on the road!

4 comments:

Marla, a very informative recall of your trials written with the wit and honesty I expected from you! Thankfully you are in excellent hands and judging from your OBVIOUSLY hand picked staff (Vin Diesel - Dr. MCDREAMY for Gods sake - geesh) I expect a speedy and complete recovery! Keep me posted and will talk later.

About Me

Marla Crider, a 60 year-old travel professional from Little
Rock, Arkansas, is blogging her battle with invasive ductal carcinoma or in layman’s terms –
breast cancer. From the moment she discovers the lurking lump in her right
breast, she apprehensively chronicles her thoughts and emotions for public
scrutiny. Be forewarned that these postings may provide a raw glimpse into the
author’s psyche and ability to deal with a life threatening challenge. Hopefully,
Marla’s honesty, humor, and prose approach of dealing with her diagnosis and
subsequent treatment plan will help others who find themselves in a crusade of
their own. You may follow her journey here: www.MarlaCrider.com . Marla has lived and worked previously in Fayetteville, Arkansas and Hot Springs, Arkansas.

Invasive Ductal Carcinoma: What is it?

Invasive ductal carcinoma (IDC) is the most common form of invasive breast cancer. It accounts for 80% of breast cancer incidence upon diagnosis, according to statistics from the U.S. in 2004. On a mammogram, it is usually visualized as a mass with fine spikes radiating from the edges. On physical examination, the lump usually feels much harder or firmer than benign breast lesions such as fibroadenoma. On microscopic examination, the cancerous cells invade and replace the surrounding normal tissues.

Mammograms

Breast tissue is composed of fatty (nondense) tissue and connective (dense) tissue. Radiologists use a grading system to describe the density of breast tissue based on the proportion of fat to connective tissue. There are four levels of density that are detected by mammograms: Level 1 (a very fatty breast), level 2 (fatty tissue makes up more than 50 percent of breast), level 3 (dense tissue makes up more than 50 percent of the breast) and level 4 (a very dense breast with very little fat). Click the image above for more information from the Mayo Clinic.

Get a Breast Cancer Screening

Click map to find a screening site near you.

All original content copyright (c) 2013, Marla F. Crider and marlacrider.com. You are free to share (copy, distribute and transmit) content from this site with attribution to marlacrider.com.